Volume 1

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Volume 1

  1. 1. Contents for Volume 1Osteoid osteoma--------------------------------Case 1-50Osteoblastoma----------------------------------Case 51-94Osteofibrous dysplasia-------------------------Case 95-101Ossifying fibroma of jawbone----------------Case 102-107
  2. 2. OsteoidOsteoma
  3. 3. Osteoid Osteoma The osteoid osteoma is the most common osteoid-forming tumorseen in the skeletal system, accounting for 10% of all benignbone tumors. It is more common in males than females with thepeak incidence in the second decade of life. The lesions producesymptoms of dull, aching pain that is more severe at night. Thepain is relieved with anti-inflammatory medication such asaspirin or non-steroidal anti-inflammatory drugs (NSAID)that inhibit the high concentration of prostaglandins found inthe nidus of the osteoid osteoma. The lesions occur typically inthe cortical structures of long bones such as the femur or tibiabut can also be found in the small bones of the ankle, wrist orvertebral column. The lesion is characteristic for its dense,sclerotic response in the cortical bone resulting in a fusiformenlargement on the surface of the cortex as a response to thesmall inflammatory nidus or granuloma (measuring up to one
  4. 4. centimeter in diameter) in the central area of the scleroticresponse. If the lesion is located in a central medullary area,such as the metaphysis or on the very superficial surface of abone, the sclerotic response is less severe. If the nidus islocated close to or within a joint structure, as in the femoralneck area, there will be a significant inflammatory synovitisin the adjacent joint that gives the clinical appearance of apyarthrosis. In the spine, the lesions are usually located in theposterior elements of the spine such as the laminae or pedicles.The lumbar spine is the most common location followed secondby the dorsal spine. Atypical secondary painful scoliosis willdevelop with the convexity seen on the side opposite theinflammatory lesion. The two most significant diagnostic imaging studies are a CTscan through the nidus area to identify its anatomic location and abone isotope scan which is invariably positive, especially in asymptomatic lesion. It is the current feeling that the osteoid.
  5. 5. osteoma is a true benign neoplasm of bone in which a com-bination of osteoclastic and osteoblastic activity are seen.There are no inflammatory cells such as lymphocytes orplasma cells as would be seen in a Brodie’s abscess. Non-steroidal anti-inflammatory medications such as prostaglandininhibitors can be very effective in controlling the disablingsymptoms and helping the patient get thru a period of one ortwo years during which time the lesion will typically involuteinto a painless lesion that does not require surgery. However,if the patient is unable to live with the pain during this time,a surgical approach is indicated. Following exposure of thelesion, a high speed burr is used to burr into the inflammatorybone that is characterized by a pinkish hyperemia. When thenidus is found, a small curette is used to core the inflammatorynidus for pathological diagnosis and the cavity of the nidusis burred an additional 2 or 3 mm which usually results in a verydramatic relief of symptoms and a permanent cure from the
  6. 6. disease process. It is not necessary to remove the largedense sclerotic bone surrounding the nidus; doing so couldresult in a pathologic fracture following surgery. In the spine,a simple laminectomy is frequently carried out. If the lesion islocated in the pedicle a simple burring into the pedicle willrelieve the patient of the inflammatory pain. More recently, relatively non-invasive techniques have beentried to remove the nidus of the osteoid osteoma by means of aCT guided burr placed through a protective trocar or by place-ment of a heat-producing radio frequency probe that, whenproperly positioned, can destroy the nidus through thermalcoagulation. These techniques are particularly valuable for deep-seated lesions located in the acetabulum. For lesions located inthe pedicle of a vertebra one must be careful not to damage anadjacent spinal root or spinal cord.
  7. 7. CLASSICCase #119 yr old female painfulOsteoid osteoma nidusfemur
  8. 8. CT scan nidus
  9. 9. Macro section of nidus
  10. 10. Photomic of nidus
  11. 11. Case #229 year maleosteoid osteomafemur nidus
  12. 12. CT scan nidus
  13. 13. Case #3 11 yr male osteoid osteoma femur
  14. 14. Bonescan
  15. 15. CT scan nidus
  16. 16. Photomic
  17. 17. Case #4 nidus 5 yr male osteoid osteoma femur
  18. 18. Case #512 yr maleosteoid osteomafemur nidus
  19. 19. Case #610 yr maleosteoid osteomafemur nidus
  20. 20. nidus
  21. 21. nidusCT scan
  22. 22. Case #730 yr femaleosteoid osteomafemur nidus
  23. 23. nidusCoronal T-1 MRI
  24. 24. nidus edemaAxial PD MRI
  25. 25. nidusMacrosection
  26. 26. Case #823 yr femaleosteoid osteomafemur nidus
  27. 27. Bone Scan
  28. 28. Nidus CT Scan
  29. 29. Case #912 yr maleosteoid osteomafemur nidus
  30. 30. Macro section nidus
  31. 31. Photomic
  32. 32. Case #10 nidus 10 yr female with osteoid osteoma femoral neck
  33. 33. Photomic
  34. 34. One yr after curettement
  35. 35. Case #11 nidus 25 yr male with osteoid osteoma femoral neck
  36. 36. nidusCT scan
  37. 37. Case #12 nidus 6 yr male osteoid osteoma acetabulum
  38. 38. nidus
  39. 39. Bone scan
  40. 40. Case #13 nidus11 yr maleosteoid osteomadistal femur
  41. 41. Bone scan
  42. 42. Case #14 nidus16 yr maleosteoid osteomadistal femur
  43. 43. Case #156 yr maleosteoid osteomatibia nidus
  44. 44. Bone scan
  45. 45. Excessivebone blockresection nidus
  46. 46. nidusMacro section of nidus
  47. 47. Photomic
  48. 48. Post op x-ray
  49. 49. Resultant fractureone year later
  50. 50. Case # 1610 yr maleosteoid osteomatibia
  51. 51. Shaving down with osteotome
  52. 52. Further shaving to find nidus
  53. 53. Burred out nidus defect
  54. 54. Case # 1715 yr maleosteoid osteomatibia
  55. 55. Lateral view nidus
  56. 56. Bone scan
  57. 57. Coronal T-2 MRI nidus
  58. 58. Coronal Gadcontrast MRI edema nidus
  59. 59. nidus T-1 axial MRI
  60. 60. Photomic
  61. 61. Photomic
  62. 62. Case #17.1 Osteoid osteoma 52 year old male with ankle pain for 3 mos.
  63. 63. Sag T-1 T-2 Gad
  64. 64. Axial T-1 T-2Gad
  65. 65. Case #18 nidus17 yr maleosteoid osteomafemur
  66. 66. Grossspecimen nidus
  67. 67. Photomic
  68. 68. Case #19 18 yr male Osteoid osteoma tibia
  69. 69. Case #2018 yr femaleosteoid osteoma nidustibia
  70. 70. Case #21 nidus 12 yr male with parosteal osteoid osteoma tibia
  71. 71. Case #22 nidus17 yr maleosteoid osteomafibula
  72. 72. Lateral view
  73. 73. Case #23 nidus26 year female withepiphyseal osteoidosteoma prox radius
  74. 74. Case #2416 yr femaleosteoid osteomaulna nidus
  75. 75. Bone scan
  76. 76. Case #2516 yr maleosteoid osteomahumerus nidus
  77. 77. Case # 26 nidus14 yr maleosteoid osteomaL-4
  78. 78. Bone scan
  79. 79. Photomic
  80. 80. Case # 27 nidus15 yr maleosteoid osteomaL-3
  81. 81. Case #28 nidus46 yr maleosteoid osteomadorsal spine
  82. 82. Bone scan
  83. 83. Case #29 nidus 18 yr male with osteoid osteoma C-3
  84. 84. nidusLaminogram
  85. 85. Bone scan
  86. 86. Case #30 nidus 12 yr male with osteoid osteoma C-3 spine
  87. 87. Case #31 nidus25 yr maleosteoid osteomaC-5
  88. 88. Case # 32 nidus 27 yr female with osteoid osteoma S-1
  89. 89. Case #33 nidus 22 yr male with osteoid osteoma sacrum
  90. 90. Case #34 nidus18 yr maleosteoid osteomafinger
  91. 91. nidusX-ray
  92. 92. nidusAP x-ray
  93. 93. Case #35 nidus 24 yr male with osteoid osteoma thumb
  94. 94. Bone scan
  95. 95. Case #36 nidus 19 yr female with osteoid osteoma finger
  96. 96. Case #37 nidus 20 yr male with osteoid osteoma thumb
  97. 97. Case #37.1 nidus 17 year female with dull aching pain index finger 1 yr
  98. 98. Case #38 nidus 23 yr male with osteoid osteoma capitate
  99. 99. Case #39 nidus 25 yr male with osteoid osteoma narvicular
  100. 100. Case # 40 nidus 34 yr female with osteoid osteoma 2nd metatarsal
  101. 101. double nidusCT scan
  102. 102. edemaAxial T-2 MRI
  103. 103. Case #41nidus 24 yr female with osteoid osteoma big toe
  104. 104. nidusGross Specimen
  105. 105. Photomic
  106. 106. Photomic
  107. 107. Case #42 nidus Osteoid osteoma talus
  108. 108. Photomic
  109. 109. Case #43Osteoid osteomapseudotumor Brodie’s abscess13 yr femaletibia nidus
  110. 110. tunnelGopher’s sign
  111. 111. Case # 44Osteoid osteomapseudotumorBrodie’s abscess nidustibia38 yr male
  112. 112. nidus Axial T-2 MRI
  113. 113. Case #45 pseudo-nidus fracture line Osteoid osteoma pseudotumor stress fracture femoral neck 38 yr male
  114. 114. Bone scan
  115. 115. Case #46Osteoid osteomapseudotumor33 year femaleEarly stressfracture femoralneck with painfor 3 mos
  116. 116. Bone scan
  117. 117. One month later
  118. 118. Case #47 pseudonidus Osteoid osteoma pseudotumor stress fracture femoral neck 50 yr female
  119. 119. pseudonidusAxial T-2 MRI
  120. 120. fracture lineCoronal T-2 MRI
  121. 121. Case #48 OO pseudotumor Stress fracture 20 year old male with pre-tibial pain for 3 months
  122. 122. Sag T-1 PD Gad
  123. 123. Case #49Pseudo osteoidosteoma femurChronic stressperiostitis fromadductor pull14 yr male
  124. 124. pseudonidus CT scan
  125. 125. Bone scan
  126. 126. Case #50Pseudo osteoidosteoma femur38 yr maleBone island
  127. 127. Bone scan
  128. 128. CoronalT-1 MRI pseudonidus
  129. 129. Osteoblastoma
  130. 130. Osteoblastoma The so-called osteoblastoma is considered by most to be a largeor giant form of the similar clinical entity known as the osteoidosteoma. As with the osteoid osteoma, it is found in children andyoung adults, more often in males than females. It is less commonthan the osteoid osteoma, representing approximately 1% of allbone tumors. It is found mostly in metaphyseal areas of long boneand in the posterolateral elements of the axial skeleton wherenearly 50% of the lesions are identified. Radiographically theselesions are more osteolytic than the osteoid osteoma and have acentral nidus that measures more than 1.5 cm in diameter withless reactive sclerosis seen at the periphery than an osteoidosteoma. It is not unusual for an aneurysmal component to beassociated with the osteoblastoma, similar to the reaction seenadjacent to chondroblastomas and giant cell tumors. The micro-scopic appearance of the nidus material is almost identical to
  131. 131. that of the osteoid osteoma and under higher power cannot bedifferentiated by even the most competent pathologists. Themajor concern is a microscopic appearance similar to an osteo-sarcoma and, for this reason, multiple samples must be evaluatedin order to establish the correct diagnosis in cases where theselesions arise from the metaphyseal areas of long bone. In the spinal area, the osteoblastoma is typically located in theposterolateral elements where it can cause problems with spinalcord or nerve root compression that may require aggressivesurgical decompression and even spinal stabilization. On occasionan osteoblastoma will spontaneously convert into an osteo-sacoma, especially if it has been treated with radiation therapy.The primary treatment for the osteoblastoma is a surgical one witha fairly aggressive curettement of the lesion. There is no particularreason to take wide margins because the recurrence rate is quitelow and in some cases the lesions resolve spontaneously with outany surgery at all, similar to what occurs with osteoid osteomas.
  132. 132. A variant of the osteoblastoma, the so-called aggressive or“malignant” osteoblastoma, is a clinical entity halfway between theclassic benign osteoblastoma and a full blown malignant osteo-sarcoma. This “malignant” osteoblastoma appears and behavesclinically at the local site like an osteosarcoma but has no potentialto metastasize to distant parts. In this situation, local treatmentmust be more aggressive and probably would require a wide localresection to avoid a local recurrence because radiation therapy oreven systemic chemotherapy is not effective for this aggressive butbenign entity.
  133. 133. CLASSICCase #5126 yr maleosteoblastoma L-4
  134. 134. Lateral view
  135. 135. Bone scan
  136. 136. CT scan
  137. 137. Sagittal T-2 MRI
  138. 138. Photomic
  139. 139. Photomic
  140. 140. 5 yrs post op with spontaneous fusion
  141. 141. AP x-ray 5 yrs post op
  142. 142. Sagittal gad contrast MRI 5 yrs post op
  143. 143. Axial gad contrast MRI 5 yrs post op
  144. 144. Case #52 nidus 23 yr male with osteoid osteoma L-5
  145. 145. nidusCT scan
  146. 146. Photomic
  147. 147. Photomic
  148. 148. RecurrenceRecurrence 8 mos post op laminectomy
  149. 149. CT Recurrence as an osteoblastoma
  150. 150. Secondary ABCbehind osteoblastoma Sagittal T-2 MRI ABC osteoblastoma
  151. 151. fluid-fluid levelAxial T-2 MRI
  152. 152. ABC histology
  153. 153. ABC histology
  154. 154. Osteoblastoma histology
  155. 155. Osteoblastoma histology
  156. 156. Post op posteriorresection and fusion
  157. 157. AP x-raypost op fusion
  158. 158. CT scan later shows anterior recurrence
  159. 159. Post op anteriorresection and bonecement reconstruction
  160. 160. Lateral x-ray showinganterior reconstructionwith cement cement
  161. 161. cementbonegraft CD rodsPost op CT scan showing cement reconstruction
  162. 162. cementgraft Post op CT
  163. 163. Case #53 surgical towel clip26 yr male with osteoblastoma L-4 following a laminectomy curettement three years previous for an osteoid osteoma
  164. 164. CT scanAppearance 4 months later with a 1.5 cm nidus
  165. 165. A curettement at this time revealed an osteoblastoma
  166. 166. Myelogram 4 yrslater
  167. 167. burned-out lesionCT scan at same time and no pain
  168. 168. Another CT cut
  169. 169. Burnt out lesionSagittal T-1 MRI at same time
  170. 170. Sagittal T-2 MRI same time
  171. 171. T-2 MRI with residual ABC in inactive lesion
  172. 172. Axial T-1 MRI same time
  173. 173. Axial T-2 MRI with residual ABC component
  174. 174. Case #547 yr femaleosteoblastoma L-2
  175. 175. Bone scan
  176. 176. T-2 MRI showshigh signal ABCposterior to low signalosteoblastoma osteoblastoma ABC
  177. 177. osteoblastomaSagittal ABCT-2 MRI
  178. 178. Osteoblastoma Photomic
  179. 179. AP x-raypost op posteriorspinal fusion
  180. 180. Lateral X-raypost op
  181. 181. Case #5514 yr femaleosteoblastoma L-5
  182. 182. Oblique X-ray
  183. 183. Bone scan
  184. 184. CT scan
  185. 185. CT scan
  186. 186. Case #56 24 yr male with osteoblastoma L-3
  187. 187. Lateral view
  188. 188. Oblique view
  189. 189. Opposite oblique
  190. 190. Case #57 22 year male with osteoblastoma L-1 vertebra
  191. 191. Oblique view
  192. 192. Case #58 23yr male with burned out obteoblastoma L-4
  193. 193. Case #5914 yr maleosteoblastoma C-3
  194. 194. Oblique view
  195. 195. Opposite oblique
  196. 196. One yearpost op posteriorfusion and recurrenttumor anterior
  197. 197. Anterior viewwith recurrence
  198. 198. Post op anteriordebriedment andfusion
  199. 199. Case #6018 yr maleosteoblastomaC-7
  200. 200. Oblique view
  201. 201. Lateral view2 mo later
  202. 202. AP view1 mo later
  203. 203. Resected nidus
  204. 204. Photomic
  205. 205. Photomic
  206. 206. Case #61CT scan 55 yr female with osteoblastoma C-6
  207. 207. Bone scan
  208. 208. Sagittal T-1 MRI
  209. 209. Sagittal T-2 MRI
  210. 210. Axial T-2 MRI
  211. 211. Case #62 25 yr female with osteoblastoma C-6
  212. 212. AP x-ray
  213. 213. 10 yrs later
  214. 214. Lateral view 10 yrs later
  215. 215. Photomic
  216. 216. Photomic
  217. 217. Case #63CT scan 40 yr male with osteoblastoma C 5-6
  218. 218. CT scan
  219. 219. Sagittal T-2 MRI
  220. 220. SagittalT-2 MRI showingbulge in floor ofvertebral canal
  221. 221. Case #64 13 yr female with osteoblastoma C-6
  222. 222. Lateral view
  223. 223. Post op X-rayAfter anteriorinterbody fusion
  224. 224. Case #65AP X-ray 14 yr female with osteoblastoma C-7
  225. 225. AP myelogram
  226. 226. Arteriogram showingpressure on vertebralartery
  227. 227. Post op debriedment
  228. 228. Case #66CT scan 43 yr female with osteoblastoma T-8
  229. 229. Axial T-2 MRI
  230. 230. Sagittal T-1 MRI
  231. 231. Post op posteriorspine fusion
  232. 232. Case #67 28 yr male with osteoblastoma thoracic spine
  233. 233. CT scan
  234. 234. Post op resection
  235. 235. CT scan post op resection
  236. 236. Case #6821 yr maleosteoblastoma S-1
  237. 237. 2 years later
  238. 238. 5 years later
  239. 239. Lateral view 5 years later
  240. 240. Photomic
  241. 241. Photomic
  242. 242. Case #69 8 yr male with ostoblastoma sacrum
  243. 243. Case #70 26 yr female with osteoblastoma acetabulum
  244. 244. Close up AP
  245. 245. Photomic
  246. 246. Photomic
  247. 247. X-ray 3 mosfollowing THA
  248. 248. Case #71 19 yr male with aggressive osteoblastoma acetabulum
  249. 249. Bone scan
  250. 250. Gross specimen from curettement
  251. 251. Photomic
  252. 252. Photomic
  253. 253. Post op internalhemipelvectomy
  254. 254. Recurrence 4 months later
  255. 255. tumorAblative hemipelvectomy specimen
  256. 256. tumor Hemipelvectomy specimen
  257. 257. Several years later with recurrent tumor on sacrum
  258. 258. Lateral view of recurrence
  259. 259. Case #7238 yr maleosteoblastomapelvis
  260. 260. Frog lateral
  261. 261. Post op x-ray following curettage and cementation
  262. 262. Case #73 33 yr female with osteoblastoma acetabulum
  263. 263. Axial T-1 MRI
  264. 264. Coronal T-2 MRI
  265. 265. Case #74 26 yr male with osteoblastoma acetabulum
  266. 266. Frog lateral
  267. 267. Case #75 24 yr male with osteoblastoma pelvis
  268. 268. 18 mos later
  269. 269. Case #76 22 yr male with osteoblastoma ischium
  270. 270. nidusX-ray of resected specimen
  271. 271. Case #77 26 yr male with osteoblastoma ilium
  272. 272. CT scan
  273. 273. Post op x-ray appearance after resection and cementation
  274. 274. Case #78 23 yr male osteoblastoma femur
  275. 275. CT scan
  276. 276. T-2 MRI
  277. 277. Sagittal T-2 MRI
  278. 278. Photomic
  279. 279. Case #78.119 year male withtibial pain for 6 mos
  280. 280. T-1 T-2 Gad +Axial
  281. 281. Coronal T-1 T-2 Gad
  282. 282. X-ray 3 months post op
  283. 283. Case #7915 yr maleosteoblastomafemur
  284. 284. Bone scan
  285. 285. CT scan
  286. 286. Axial T-2 MRI
  287. 287. Coronal T-1MRI
  288. 288. X-ray at time ofsurgery with markerin tumor defect
  289. 289. Photomic of nidus
  290. 290. Case #79.1 CT scan Sclerosing osteomyelitis of Garre 14 yr male with dull aching thigh pain for 1 year
  291. 291. Coronal T-1 Coronal T-2
  292. 292. Sagittal T-2 Axial T-2
  293. 293. Case #80 13 yr male with osteoblastoma femoral neck frog lateral view
  294. 294. AP view
  295. 295. Bone scan
  296. 296. Case #81 22 yr male with osteoblastoma talus
  297. 297. Sagittal T-1 MRI
  298. 298. Coronal T-2 MRI
  299. 299. Coronal T-2 MRI
  300. 300. Photomic
  301. 301. Case #8225 yr maleosteoblastomatalus
  302. 302. Lateral view
  303. 303. Close up lateral
  304. 304. Photomic
  305. 305. Case #83 18 yr female with osteoblastoma talus
  306. 306. Mortise view
  307. 307. X-ray 1 yr after curettage
  308. 308. Case #84 23 yr male with osteoblastoma talus
  309. 309. Case #85 25 yr female with osteoblastoma os calcis
  310. 310. Os calcis view
  311. 311. X-ray several months with progression of disease
  312. 312. Case #86 29 yr male with osteoblastoma os calcis
  313. 313. Case #87 53 yr male with osteoblastoma distal humerus
  314. 314. X-ray 3 years later
  315. 315. tumor edema Axial T-2 MRI
  316. 316. edema nidusCoronal T-2 MRI
  317. 317. Post op x-rayfollowing distalhumeral resectionand allograftreconstruction
  318. 318. Case #889 yr femaleosteoblastomadistal humerus
  319. 319. Coronal T-1 MRI edema
  320. 320. tumoredema Axial T-2 MRI
  321. 321. Case #88.1 nidus11 yr male with ABC response to osteoblastoma humerus
  322. 322. Sag T-1Sag T-2
  323. 323. Axial T-2 MRI shows the multiloculated aneurysmal cysts
  324. 324. Case #89 21 yr male with osteoblastoma ring finger
  325. 325. AP and Lateral radiographs
  326. 326. Gross specimen
  327. 327. Photomic
  328. 328. Case #90 18 yr male with osteoblastoma finger
  329. 329. Case #91 21 yr male with osteoblastoma thumb
  330. 330. Case #92 10 yr female with osteoblastoma finger tip
  331. 331. AP X-ray
  332. 332. Case #939 yr femaleosteoblastoma tibia
  333. 333. AP x-ray
  334. 334. Case #94 24 yr male with osteoblastoma fibula
  335. 335. Lateral view
  336. 336. Osteofibrous Dysplasia
  337. 337. Osteofibrous Dysplasia Osteofibrous dysplasia is a rare condition occurringin children less than 10 years of age. This benign lesionhas radiographic and microscopic features similar to fibrousdysplasia of the tibia, the main difference being the presenceof more heavily ossified tissue at the periphery of the lesiongiving it a soap-bubbly appearance on x-ray. Microscopicallyit has a similar “alphabet-soup” metablastic bone appearancein a benign fibrous tissue stroma but with the additional featureof heavy osteoblastic rimming of the trabeculae not seen infibrous dysplasia. It typically arises from the anterior cortex ofthe tibia at mid shaft and causes a progressive anterior bowingof the tibia over time, creating a cosmetic deformity associatedwith pain of a dull, aching nature. The radiographic appearanceIs very similar to and impossible to separate from that of theMalignant adamantinoma that also affects the tibia in children
  338. 338. and, for this reason, a biopsy must be performed to rule out themalignant possibility. Occasionally osteofibrous dysplasia of thetibia can progress gradually into a well-differentiated formof the adamantinoma, which will have the microscopicfeatures of both osteofibrous dysplasia and adamantinomain the same lesion. As far as treatment is concerned, earlysurgical debriedment and bone grafting before age 15 yearsresults in a high local recurrence rate and thus should bediscouraged until the child reaches full bone maturity at whichtime a definitive debriedment and bone grafting procedurecan be performed without significant risk of recurrence. Thislesion occurs bilaterally in a very small percentage of casesand can also involve the fibula on the same side. This processin newborns appears to be more osteolytic and destructive innature.
  339. 339. CLASSICCase #95 9 yr male osteofibrous dysplasia tibia
  340. 340. AP and lateral x-ray
  341. 341. Photomic
  342. 342. Case #96 6 year female osteofibrous dysplasia tibia
  343. 343. Same case
  344. 344. Case #97 16 year female osteofibrous dysplasia tibia
  345. 345. Case #98 8 yr male osteofibrous dysplasia tibia
  346. 346. X-ray appearance3 yrs later
  347. 347. 8 yrs later withspontaneous healing
  348. 348. Case #98.1 Burnt out osteofibrous dysplasia 61 year old male with incidental finding in tibia for years
  349. 349. Bone scan
  350. 350. Sag T-1 PD FS Gad
  351. 351. Cor STIR Gad
  352. 352. Axial T-1 T-2 FS Gad
  353. 353. Case #99 15 yr female osteofibrous dysplasia tibiaAP x-ray
  354. 354. Lateral x-ray
  355. 355. Case #100 Newborn with osteofibrous dysplasia tibia
  356. 356. edemaT-2 axial MRI
  357. 357. Photomic
  358. 358. Photomic
  359. 359. X-ray 1 yr later
  360. 360. Case #101Another newbornosteofibrous dysplasiatibia
  361. 361. Another view
  362. 362. Ossifying Fibroma of Jawbone
  363. 363. Ossifying Fibroma of Jawbone Ossifying fibroma of jawbone is a benign condition similar toosteofibrous dysplasia of the tibia in that histologically they arealmost identical. It is also a condition that is related to fibrousdysplasia, which can have a very similar radiographic appearance,but in the case of fibrous dysplasia of jawbone osteoblasticrimming of the trabecular bone is not seen under microscopicevaluation. As with fibrous dysplasia, this condition is found inchildren and is almost always an asymptomatic process resultingin cosmetic deformation of the maxilla or mandible, usually onone side but can be bilateral. The condition can result insignificant malocclusion of the teeth because of deformationof the subadjacent alveolar ridge or maxillary structures. It alsocan create problems with normal drainage from the air sinuses inthe maxilla that can lead to infection requiring surgical drainage.Most of the surgical treatment for this condition is for cosmeticdeformity.
  364. 364. Case #102 5 yr female ossifying fibroma maxilla
  365. 365. tumorMaxillary view
  366. 366. tumorTomogram cut
  367. 367. tumorCT scan
  368. 368. tumorAnother cut
  369. 369. Another cut
  370. 370. Photomic
  371. 371. Case #103 18 yr female with ossifying fibroma mandible
  372. 372. Oblique view
  373. 373. Photomic
  374. 374. Closeup of alphabet-soup metaplastic bone
  375. 375. Case #104 tumor 12 yr female with ossifying fibroma mandible
  376. 376. Opposite ramus
  377. 377. Case #105 14 yr female with ossifying fibroma mandible
  378. 378. Case #106 Young adult tumor osteoma skull
  379. 379. tumorOccipital view
  380. 380. Lateral view
  381. 381. Case #107 Cementoma mandible
  382. 382. Oblique view

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